Medical Students’ General Beliefs and Specific Perceptions about Patient Feedback Before and after Training in a Clinical Context

Introduction: Despite its high potential, patient feedback does not always result in learning. For feedback to be effective students must engage with it, which partly depends on their perceptions of feedback. To better understand student engagement with patient feedback in a clinical context, this study explored the following research questions: 1) What are medical students’ general beliefs about patient feedback and what are their specific perceptions of feedback messages? 2) What is the difference between these general beliefs and feedback message perceptions before and after patient feedback training? Methods: The study context was a 12-week clerkship combining Pediatrics and Gynecology, which included feedback training for students and asking for patient feedback. Ninety 4th-year medical students completed pre- and post-clerkship questionnaires. The questionnaires (Beliefs about Patient Feedback Questionnaire, Feedback Perception Questionnaire) were adapted from validated peer-feedback questionnaires. Questionnaires were quantitatively analyzed. Results: Both pre- and post-clerkship, students had positive general beliefs about patient feedback and positive perceptions of the feedback messages they received. However, paired t-tests showed that students’ general beliefs and feedback message perceptions became less positive after feedback training and experience. Discussion: Patient feedback is not an easy means to learn and students do not become feedback literate in terms of patient feedback overnight. We suggest that future researchers further explore reasons for the decline in positive perceptions of patient feedback. We suggest implementing longitudinal feedback training in medical curricula, where students are guided and supported in the complex task of learning from patients through feedback.

Using Wooclap and plenary discussion we discuss the following questions:  Which criteria did they meet?How did this contribute to their feedback dialogue? Which criteria did they not meet?Why not?  What would you do the same next time?What would you do differently?

Emotional impact
The emotional impact of feedback is discussed.By diving students in duo's, followed by plenary discussion we discuss the following questions:  How did you feel after receiving patient feedback?Why?How did you handle this emotional impact? Did you experience negative emotions?Which ones?Why?How did you handle this emotional impact?When a student experienced negative emotions, the option to discuss this after the session one-onone with the teacher is provided.

Sense-making feedback message
Students analyze and interpret their feedback message(s) by making comparisons.(refNicol) First, the feedback message of one student is analyzed plenary, so students become familiar with the comparisons.Then students are given a hand-out: they fill in the first part individually, followed by group discussion.Students answer the following questions by filling in the hand-out:  What was the feedback message? How does the feedback message compare to my self-assessment of the situation? How does the feedback message compare to your learning goal and criteria for this goal? How does the feedback message compare to feedback from others and previous situations? What is your conclusion regarding the feedback?(accept/reject)  What is your conclusion regarding your learning goal?Action-planning Students develop an action plan to use the feedback they received.
First, students individually fill in the second part of the hand-out where they answer the questions below.Second, they discuss their action plan in duo's.

APPENDIX 3 -FPQ principal component analysis
The FPQ consists of 5 scales, namely fairness (FA, 3 items), usefulness (US, 3 items), acceptance (AC, 3 items), willingness to improve (WI, 3 items) and affect (6 items).In our study we used 4 out of 5 scales: FA, US, AC, WI.The FA, US and AC together constitute a second order scale, namely the perceived adequacy of feedback (PAF).The PAF relates to the cognitive function of feedback.The WI relates to the motivations function of feedback.The underlying structure of our adjusted questionnaire was explored by conducting factor analyses on the FPQ data of the first moment students filled in this questionnaire.The pattern matrix and scree plot were used to determine the number of components, and factor loadings were used to interpret the components.First, we performed a non-fixed principal component analysis with direct oblimin rotation.This resulted in four components, which together explained for 75,80% of the total variance, see the table 1 below for factor loadings.However, the structure of the questionnaire did not follow the original structure (FA, US, AC and WI) as described by Strijbos et al., which would hinder comparability of our results with other studies. 29Therefore, we perfomed a second analysis: we tested whether the questionnaire could be divided in a cognitive and motivational dimension.We performed a principal component analysis with the factor amount fixed on 2. This resulted in two components that explained for 57,06% of the total variance, and which matched the original structure: component 1 consisted of the fairness, usefulness and acceptance items, reflecting the cognitive function in term of the PAF scale; component 2 consisted of the willingness to improve items, reflecting the motivational function.Thus, we decided to use the PAF and WI scale for analyses.Factor loadings for the two scales ranged from 0,46-0,91, see table 2 below.The internal consistencies of the PAF and WI scale had sufficient reliability (Cronbach's alpha>0.8).
conversation Students reflect on their feedback conversations and compare these to 4 criteria of the Westerveld framework for feedback dialogues: open & respectful, relevant, timely, dialogical.(ref) Lastly, action plans are discussed in plenary discussion. Based on your conclusions regarding the feedback and your learning goal, what did you learn about your strengths and weaknesses of your performance? How are you going to implement what you learned in future situations?When, where, and how can you apply what you learned? What will be your new learning goal?Or: how will you adjust your previous learning goal? How are you going to reach this (adjusted) learning goal?